Abstract
Background
Food frequency questionnaires (FFQs) are often used to assess dietary intakes due
to their ability to assess intake over extended periods, their low respondent burden,
and their cost-effectiveness. A quantitative FFQ that includes locally appropriate
food items for 5-year-old children in a multiethnic Asian population was developed,
but its validity has not previously been evaluated.
Objective
To evaluate the relative validity of a newly developed FFQ as a dietary assessment
tool for 5-year-old children in a multiethnic Asian population.
Design
The 112 –food item FFQ was administered by trained interviewers to caregivers of children.
Frequency of food items consumed in the previous month and portion size information
were collected. The FFQs were evaluated against 3-day nonweighed diet records (DRs)
completed by caregivers.
Participants/setting
The dietary data of 361 children aged 5 years from the Growing Up in Singapore Towards
Healthy Outcomes mother-offspring cohort were collected in 2015-2016.
Main outcome measures
Nutrients of interest included energy, macronutrients, fiber, cholesterol, vitamin
A, beta carotene, calcium, and iron, calculated from the FFQs and DRs.
Statistical analyses performed
Nutrient intakes according to FFQs in relation to DRs were assessed using Pearson’s
correlation, Lin’s concordance, Bland-Altman plots, quintile joint classification,
and Cohen’s κ statistics.
Results
The highest energy-adjusted correlation (Pearson’s r=0.71) and concordance (Lin’s concordance=0.69) were observed for calcium. Fiber,
saturated fat, polyunsaturated fatty acids (PUFA), cholesterol, and iron also showed
correlation coefficients and concordance of at least 0.40. Bland-Altman plots suggested
no substantial bias across ranges of intakes for the nutrients with correlations and
concordance of 0.40 or above. Quintiles joint classification showed substantial agreement
for calcium (κ=0.66), and moderate agreement for iron, fiber, saturated fat, polyunsaturated
fat, and beta carotene (κ=0.59, 0.54, 0.49, 0.44, 0.43, respectively).
Conclusions
The newly developed FFQ is in reasonable agreement with DR for estimating intakes
of calcium, fiber, saturated fat, PUFA, cholesterol, and iron. In addition, the FFQ
is able to classify children according to quintiles of nutrient intakes, with moderate
to substantial quintile agreements between FFQ and DR for calcium, iron, fiber, saturated
fat, PUFA, and beta carotene. To assess the remaining nutrients, DR method is recommended
instead of the FFQ.
Keywords
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Biography
R. Sugianto is from the Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
Biography
M. J. Chan, is from the Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
Biography
B. C. Tai is from the Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
Biography
M. F.-F. Chong is from the Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
Biography
S. F. Wong is from the Agency for Science, Technology and Research, Singapore.
Biography
L. P.-C. Shek is from the Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Biography
Y. S. Chong is from the Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Biography
K. H. Tan is from the Duke-NUS Medical School, Singapore.
Biography
K. M. Godfrey is from the NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
Article info
Publication history
Published online: December 19, 2019
Accepted:
September 26,
2019
Received:
March 13,
2019
Footnotes
STATEMENT OF POTENTIAL CONFLICT OF INTEREST K. M. Godfrey and Y. S. Chong have received reimbursement for speaking at conferences sponsored by companies selling nutritional products. They are part of an academic consortium that has received research funding from Abbott Nutrition, Nestec, and Danone. None of the other authors report any potential conflict of interest.
FUNDING/SUPPORT This research was supported by the Singapore National Research Foundation under its Translational and Clinical Research (TCR) Flagship Programme and administered by the Singapore Ministry of Health’s National Medical Research Council (NMRC), Singapore (NMRC/TCR/004-NUS/2008; NMRC/TCR/012-NUHS/2014). K. M. Godfrey is supported by the UK Medical Research Council (MC_UU_12011/4), the National Institute for Health Research (NIHR Senior Investigator (NF-SI-0515-10042) and the NIHR Southampton Biomedical Research Centre) and the European Union (Erasmus+ Capacity-Building ENeASEA Project and Seventh Framework Programme (FP7/2007-2013), projects Early Nutrition and ODIN under grant agreement numbers 289346 and 613977).
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© 2020 by the Academy of Nutrition and Dietetics.
